| Consultation office low complexity CPT 99243 • Office Visits | $121 | $121 | $121 |
| Consultation office high complexity CPT 99245 • Office Visits | $242 | $242 | $242 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,174 | $1,174 | $1,174 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $204 | $204 | $204 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $507 | $507 | $507 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,185 | $1,185 | $1,185 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $341 | $341 | $341 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $815 | $815 | $815 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $118 | $118 | $118 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $59 | $59 | $59 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $27 | $27 | $27 |
| Fundus photography CPT 92250 • Ophthalmology | $10 | $10 | $10 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $54 | $54 | $55 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,501 | $1,501 | $1,502 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,199 | $1,199 | $1,199 |
| Lateral epicondylitis open treatment CPT 24357 • Orthopedics | $357 | $357 | $357 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $279 | $279 | $279 |
| Tendon sheath incision trigger finger CPT 26055 • Orthopedics | $520 | $520 | $520 |
| Total knee replacement CPT 27447 • Orthopedics | $1,062 | $1,062 | $1,062 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $488 | $488 | $488 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $766 | $766 | $766 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $141 | $141 | $141 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $455 | $455 | $455 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $69 | $105 | $141 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $91 | $164 | $236 |
| Epidural injection lumbar or sacral without imaging CPT 62322 • Pain Management | $69 | $69 | $69 |
| Peripheral nerve block injection CPT 64450 • Pain Management | $36 | $36 | $36 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $44 | $44 | $44 |
| Facet joint nerve destruction lumbar first level CPT 64635 • Pain Management | $399 | $399 | $399 |
| Facet joint nerve destruction lumbar each additional CPT 64636 • Pain Management | $221 | $221 | $222 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $20 | $20 | $20 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $21 | $21 | $21 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $178 | $178 | $178 |
| Frozen section pathology first specimen CPT 88331 • Pathology | $25 | $25 | $25 |
| Morphometric analysis tumor quantitative CPT 88360 • Pathology | $75 | $75 | $75 |
| Microdissection manual CPT 88381 • Pathology | $131 | $131 | $131 |
| Hot or cold packs application CPT 97010 • Physical Therapy | $2 | $2 | $3 |
| Electrical stimulation unattended CPT 97014 • Physical Therapy | $5 | $5 | $5 |
| Vasopneumatic device therapy CPT 97016 • Physical Therapy | $5 | $5 | $5 |
| Electrical stimulation attended each 15 minutes CPT 97032 • Physical Therapy | $6 | $6 | $6 |
| Ultrasound therapy each 15 minutes CPT 97035 • Physical Therapy | $6 | $6 | $6 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $20 | $20 | $20 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $23 | $23 | $23 |
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $14 | $14 | $14 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $18 | $18 | $18 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $12 | $12 | $12 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $66 | $66 | $66 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $66 | $66 | $66 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $32 | $32 | $33 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $17 | $17 | $17 |